Correspondence (letter to the editor): Definition Should Be Changed

The abolishment of the infamous “tender points” as the most important criterion of fibromyalgia syndrome (FMS) is a very welcome move. However, with regard to a definition of FMS, this brings with it further problems: the pathology of FMS used to be inadequately defined; now it is hardly defined at all. I find it rather dubious if epidemiological scientific efforts and the resultant therapeutic recommendations (current German S3 guideline FMS) relate to a group of patients with inclusion criteria that are as vague as “pain in the axial skeleton (cervical spine or frontal thorax or thoracic spine or lumbar spine), pain in the right and left half of the body, pain above and below the waist, sensation of stiffness/swelling in hands, feet, or face, or other physical or mental fatigue or sleep disturbances.” As a doctor having 20 years’ clinical experience with FMS patients I would change the definition as follows: FMS is a pathology that is characterized by a long term, generalized, vertebrogenic, functional disorder that manifests with multiple sensorimotor, particularly painful local symptoms, which are transmitted by reflex action, in the upper and lower extremities, the head, the trunk, and the inner organs; generalized trophic inflammatory soft tissue disorders; and psychovegetative exhaustion as a result of pain. The patient group with these or further specified inclusion criteria should become the subject of scientific research. By this, I do not only mean statistical-epidemiological but primarily clinical-physiological basic research. From the positions of traditional segment anatomy (metameric structure of the body [1]) and modern pain physiology (neurogenic inflammation, central and peripheral pain sensitization [2]), I do not believe that the pathology of fibromyalgia syndrome is etiopathogenetically unexplained but very clearly vertebrogenic, related to the metameric structure, and mediated in a trophic-vegetative way (3).